Geographic Disparity in Deceased Donor Liver Transplant Rates Following Share 35

Transplantation
Mary G BowringS E Gentry

Abstract

The Organ Procurement and Transplantation Network implemented Share 35 on June 18, 2013, to broaden deceased donor liver sharing within regional boundaries. We investigated whether increased sharing under Share 35 impacted geographic disparity in deceased donor liver transplantation (DDLT) across donation service areas (DSAs). Using Scientific Registry of Transplant Recipients June 2009 to June 2017, we identified 86 083 adult liver transplant candidates and retrospectively estimated Model for End-Stage Liver Disease (MELD)-adjusted DDLT rates using nested multilevel Poisson regression with random intercepts for DSA and transplant program. From the variance in DDLT rates across 49 DSAs and 102 programs, we derived the DSA-level median incidence rate ratio (MIRR) of DDLT rates. MIRR is a robust metric of heterogeneity across each hierarchical level; larger MIRR indicates greater disparity. MIRR was 2.18 pre-Share 35 and 2.16 post-Share 35. Thus, 2 candidates with the same MELD in 2 different DSAs were expected to have a 2.2-fold difference in DDLT rate driven by geography alone. After accounting for program-level heterogeneity, MIRR was attenuated to 2.10 pre-Share 35 and 1.96 post-Share 35. For candidates with MELD 15-34, MIRR ...Continue Reading

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Citations

Feb 13, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Christine E HaugenSommer Gentry
Jul 26, 2019·Transplantation·Timucin Taner, Julie K Heimbach
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May 21, 2020·JAMA Surgery·Jayme E LockeNancy L Ascher
Jan 3, 2020·Transplantation·Douglas MogulEvelyn Hsu
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Oct 1, 2019·Transplantation·Timucin Taner, Julie K Heimbach
Aug 1, 2020·Transplantation·Douglas B MogulEvelyn Hsu
Feb 23, 2021·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Nabeel A WahidRobert S Brown
Aug 11, 2021·Current Opinion in Organ Transplantation·Fabio MelandroDavide Ghinolfi
Aug 20, 2021·Current Opinion in Organ Transplantation·Paolo R Salvalaggio
Aug 17, 2021·Clinical Transplantation·Nicholas R HessArman Kilic

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